Premium
Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study: associations with maternal body mass index
Author(s) -
H. David McIntyre
Publication year - 2010
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2009.02486.x
Subject(s) - medicine , body mass index , percentile , odds ratio , pregnancy , obstetrics , confidence interval , mass index , confounding , gestation , obesity , statistics , mathematics , biology , genetics
Please cite this paper as: HAPO Study Cooperative Research Group. Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study: associations with maternal body mass index. BJOG 2010;117:575–584. Objective To determine whether higher maternal body mass index (BMI), independent of maternal glycaemia, is associated with adverse pregnancy outcomes. Design Observational cohort study. Setting Fifteen centres in nine countries. Population Eligible pregnant women. Methods A 75‐g 2‐hour oral glucose tolerance test (OGTT) was performed between 24 and 32 weeks of gestation in all participants. Maternal BMI was calculated from height and weight measured at the OGTT. Fetal adiposity was assessed using skinfold measurements and percentage of body fat was calculated. Associations between maternal BMI and pregnancy outcomes were assessed using multiple logistic regression analyses, with adjustment for potential confounders. Main outcome measures Predefined primary outcomes were birthweight >90th percentile, primary caesarean section, clinical neonatal hypoglycaemia and cord serum C‐peptide >90th percentile. Secondary outcomes included pre‐eclampsia, preterm delivery (before 37 weeks) and percentage of body fat >90th percentile. Results Among 23 316 blinded participants, with control for maternal glycaemia and other potential confounders, higher maternal BMI was associated (odds ratio [95% confidence interval] for highest {≥42.0 kg/m 2 } versus lowest {<22.6 kg/m 2 } BMI categories) with increased frequency of birthweight >90th percentile (3.52 [2.48–5.00]) and percentage of body fat >90th percentile (3.28 [2.28–4.71]), caesarean section (2.23 [1.66–2.99]), cord C‐peptide >90th percentile (2.33 [1.58–3.43]) and pre‐eclampsia (14.14 [9.44–21.17]). Preterm delivery was less frequent with higher BMI (0.48 [0.31–0.74]). Associations with fetal size tended to plateau in the highest maternal BMI categories. Conclusion Higher maternal BMI, independent of maternal glycaemia, is strongly associated with increased frequency of pregnancy complications, in particular those related to excess fetal growth and adiposity and to pre‐eclampsia.